Antimicrobial Drugs: Recent Advances Provide Great News, Yet We Are Losing the Bigger Battle

During a time as director general of the WHO, a past official famously stated that all of the “simple” antimicrobials had already been found. The argument was that in addressing the pressing threat of antibiotic-resistant infections, we would face difficulties to discover new treatments – or preserve the existing ones – without finding novel approaches of working. This assessment proved accurate.

A Slow and Challenging Pipeline

Since 2017, just sixteen antimicrobial agents have received widespread official clearance – primarily close relatives of medicines already in use and thus unlikely to overcome resistance for long. The development of novel compounds is a slow and financially unattractive endeavor, given that one-off treatments are not as profitable as ones managing longer-term conditions. The scientific outlook continues to be grim.

A Glimmer of Optimism and a New Model

Nevertheless, the recent announcement of two new FDA-approved antibiotics against gonorrhoea is a welcome development and, crucially, validates a innovative method of incentivising research. One of the recently approved medications, Zoliflodacin, is the result of a unique type of partnership between a Swiss non‑profit and a drug firm. The public health partnership supplied funding and managed testing phases to offset expenses and navigate approval processes. This sort of assistance upfront helps steer the sector towards areas of most pressing global need.

This approach and a separate praised “subscription model” – launched to ensure income to companies that invest in certain antibiotics – represent the strongest chance of sustaining a dripfeed of novel treatments from the current system.

The Inevitable Challenge of Resistance

But even hurrying the development of drugs in the pipeline isn't sufficient. The new drug is sometimes described as a novel type of antibiotic, indicating it targets a part of the infectious bacteria that no other drug does, in principle forcing the bacterium to begin anew in evolving a defense to it. Scientists and physicians are relieved to have a new option for gonorrhoea – which has resistant strains to every known antibiotic – but caution that eventual drug resistance to it is certain.

As has grown customary with recent antimicrobials, there is consequently an argument about whether it should be held in reserve, rationed to highly resistant cases only – confining its use to situations where high‑end lab testing is available. This sort of rational strategy should be the worldwide norm, but frequently can't be deployed readily in many regions.

A Dwindling Pipeline of Innovation

More broadly, it is hard to see where the stream of additional novel antimicrobials we need could possibly come from. The former official's comment nodded to the fact that searching the living world for natural sources – as with the first antibiotic – has had diminishing returns. Use of artificial intelligence has been proposed to speed up the search, although a highly-touted initial discovery found in recent years has not yet advanced past animal trials. Fully lab-created compounds, which are mainly or fully lab-created, are constantly in development, but often run up against the iron laws of molecular science – the fact that we imagine a compound does not guarantee we can create it easily.

Running Fast to Stand Still

The prevailing expert assessment is that when it comes to antimicrobials, we must move with great speed truly just to remain in the same place. Prudent, internationally coordinated use is the sole method to preserve our therapeutic edge. Regrettably, the magnitude of future breakthroughs is likely to seem miserly in contrast to the therapeutic revolution of the 20th century.